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I almost lost my breakfast this morning upon reading in today’s New York Times that a man named Pedro Hernandez, who confessed to police last week to murdering six-year-old Etan Patz thirty-three years ago, also confessed to some relatives and to a charismatic Christian group thirty years ago. I can’t even imagine how Etan’s parents feel.

This “Christian” group apparently encouraged (or maybe still encourages) participants to “feel the Holy Spirit and unburden themselves of guilt for their sins.” The Times further describes the charismatic Christian gathering in Camden that Mr. Hernandez attended 30 years ago a “free-for-all of admissions of guilt, sometimes shocking.” Furthermore, the article says, the “groups grow hardened and numb to hearing them,” and that one Mr. Rivera explained it by saying that it wasn’t his “place” to tell because the confession wasn’t made to him alone, one-on-one, but to the group.

This is probably an accurate expression of Mr. Rivera’s own psychological rationalization. But wow. That is some religion. Defenders of religion often try to say that we need religion to instill morality, and manage to ascribe this kind of immorality to zealots of “other” religions, but how do we find the morality in any philosophy that would encourage silence and rationalization in the face of such a confession? How do we reconcile an ethic that finds the “Holy Spirit” powerful enough and sufficient to relieve the guilt of a child murderer? Or that puts protected confession above any feeling of empathy for the parents of that murdered little boy? How do we cope with a religion that puts so called “faith” above a proper, conscience-guided sense of right and wrong? Examples abound of religion–all religions, in history and currently–encouraging blind adherence to zealotry and faith, and/or protection of a misguided, entrenched hierarchy over the development of a moral conscience that can distinguish right from wrong, but really, this all still all reminds me of Eichmann’s Nuremberg defense that he was ” just following orders.”

One has to wonder what other confessions these people heard. Isn’t there a priest somewhere who understands and can distinguish right from wrong, and could have advised these people?

Who would have ever thought there could be a controversy around grief?

In the last few months, in my other (non-writing) life as a therapist, I have heard the devastating stories of several people seriously traumatized by their past contacts with the mental health system, people with a lasting legacy of pain from being (probably wrongly) prescribed powerful psychiatric drugs or placed against their will on a terrifying psych ward. I’m definitely not a conspiracy theorist, one who says things like “everything happens for a reason,” or assigns existential “meaning” to every happening, and so I’m sure it’s pure coincidence that I’ve heard so many stories like this lately. I obviously recognize that many dedicated people in the field are doing work that manages to be both life-saving and compassionate, yet these awful stories also underscore the need for folks setting the parameters in the field–the task force considering changes in the upcoming edition of the “bible” for clinicians, the Diagnostic and Statistical Manual (so-called “DSM V) to the various “diagnoses” around grief–to at least try to get it right. It seems to me that those of us working in the field who are honored every day to do this work, to witness people’s deepest pain, have a duty to at least speak out when it appears that a grave and possibly for some folks dangerous injustice is being contemplated.

Partly because of the experience I mention above, and partly as a response to a wonderful “Open Letter to to the DSM Task Force” posted by Dr. Joanne Cacciatore on her own website (which I’m linking to here) , I’d like to add my own voice to all those professionals and offended bereaved people weighing in on this disturbing and upsetting controversy.

As readers of this blog surely know, I too lost lost a child, my son, Michael, who died in 1994, and I’ve been living with, and thinking, studying, and writing about grief ever since. (Let me assure the reader that I’ve also done lots of other things, including recover my sense of humor.) My writing inspired by this includes a highly acclaimed novel, “Saving Elijah,” published by Putnam in June, 2000. After that I (eventually) went back to grad school to get a second masters degree in social work, mostly in order to work with the bereaved, even though I already knew from experience what one bereaved human being needs from another human being. More recently I’ve been working on a kind of memoir, which I’m calling, “Excerpts: Complicated Grief.” Included in the memoir is a recounting of the day I first heard in grad school that we were to label grief that lasts longer than two months (now according to all accounts of the upcoming DSM V apparently further reduced to two weeks) as pathology, call it “complicated,” call it a “disorder.” Even twelve years after my son’s death, this felt like an accusation. How could it not? How could they not see that this is damaging to the very people it purports to “help?” It was as if feeling the terrible sorrow I had felt, sometimes even still felt (still sometimes feel now), wasn’t “normal.” Yet I knew full well that it was “normal,” both from my own experience and from talking to scores, even hundreds of other bereaved parents.

I’ve written the memoir in the second person, and it moves backward from the present to the day of the loss, in an attempt to show how grief can (while still being “normal”) reverberate throughout every corridor of a life, sometimes louder, sometimes softer, sometimes as a source of wisdom, sometimes as source of pain or anxiety, but always present.

It opens on what would have been my son’s 21st birthday.

October 22, 2011, seventeen years after. Stand at the dryer, slap in wet clothes, try to form an image of a strapping young man turning twenty-one today. See only a sturdy toddler. Like a failed magic trick.

Go to the cemetery, brush away leaves, place stones on the brass and marble marker. Stand in the thick, humid air. Say Kaddish, forget the last part. Try to remember Michael but conjure up only bones in a tomb, shreds of boy and turtle, earthworms, fecund soil. Say the word fecund aloud, the hard k sound rattling the teeth. Remember your husband falling into the grave. Wonder why you come. Get back into your car pursing your lips as if tasting something moldy. Think of old metaphors, new similes. Grief always comes alone to a child’s grave. Grief is no longer a thundering, hissing monster. Grief is hollow now, like the blunt thud of rock on stone…….

The core problem comes in my view from the pathologizing of the normal human emotion of grief by calling it any kind of a disorder. And so whether you call it an “adjustment disorder related to bereavement,” and give it one year before you dial it up into an even more serious “disorder,” or whether it becomes “major depressive disorder” at two months, or at two weeks, seems to me secondary to the fact that it is called a disorder in the first place.

A child’s death? At two weeks you’re still in shock. You’re just getting started at two months. Maybe. Actually, it seems to me that it would actually be “abnormal” for a parent who lost a child to not feel overwhelmed and debilitated by sorrow (and to experience many of the attendant symptoms that echo but are not the same as those for depression) at two months out, let alone two weeks out. I would venture to say this is probably true even at one year. I remember visiting a friend of my mother’s who at age 100 was still talking about her fifteen-year-old son’s death in a car accident fifty years before as if it had happened that day. Personally, I would still call hers “normal” grief. And so the learned people figuring out the DSM seem to have had it backwards all along, and now seem to be doubling down on having it backwards.

I certainly agree that what people who have suffered loss need is (as Dr. Joanne says), human connection, caring, and compassion, or as the Lancet said: Time, Compassion, Remembrance, Empathy. I believe it’s an insult to think that a pill could be any kind of substitute for that. I remember a good, well meaning friend wanted me to take medication, but even though I was suffering mightily, walking around in my bathrobe (not only figuratively) for three years, I somehow knew that it would do no good at all to try and mask the symptoms, because a certain amount of tears needed to be shed. Luckily no clinician suggested medication. I’m not sure what I would have done, given my state of mind, if one had. The idea that we can “medicate” away the pain of grief isn’t about the bereaved, it’s about those who are uncomfortable with being witness to pain. As Rumi says,

We are pain and what cures pain, both. We are the sweet cold water and the jar that pours. I want to hold you close like a lute, so that we can cry out with loving. Would you rather throw stones at a mirror? I am your mirror and here are the stones.

In other words, the healing from the pain is in the pain. So it is.

My favorite definition of compassion is the Buddhist one: “Willingness to be close to suffering.” That’s what I do, what all of us who want to help do, we open our hearts to someone’s suffering. We witness. We don’t try to fix it. I always say: Be present. Be humble. Be patient. Observe. Reflect. Allow silence. Don’t judge. Accept. Listen

It seems to me that this isn’t only about the pharmaceutical industry, it’s even more about the insurance industry, which seems to be in the business of not paying for whatever it can possibly get out of. (And not just in the area of grief.) In this case the insurance industry seems to want to get out of any paying for anything other than that which has medication as the first line of treatment, and which labels grief a “mental illness,” or a “disorder” of some kind (an outcome that can stay in a person’s record forever, with terrible, terrible consequences).

It’s a sickening conundrum, it puts people who want to provide support for the bereaved who seek it in a terrible position, and of course it puts the bereaved in an even worse position. Aren’t we trying to help them? Surely we are. And one of the things we must do to help them is “normalize” what they’re feeling. Yes, I wailed at the top of my lungs in a hospital room, but so would you.

As clinicians, we have the “V” bereavement code, but insurance generally doesn’t pay for treatment if you use this as a diagnosis. To receive payment from insurance, it has to be a “disorder.” And so to get insurance to cover our effort to help people make their way through grief, we are actually forced to call it some kind of disorder, even when we know it isn’t. (This is, by the way, actually true for many situations, for example anger management. Insurance won’t pay for people looking for help with “anger issues” unless you slap on a some kind of a “disorder” label.

Some, no doubt, will think I’m a hopeless idealist, or a radical left winger for believing that Americans, the “richest” country on earth, ought to provide universal health care that enables people to get the health care they need, no matter what their financial or job situation. I don’t care. I still must speak the truth as I see it. And there simply ought to not only be health care for all, there should be some other terminology that acknowledges the debilitating nature of what I’ve called “big time grief,” and also provides coverage for people to get the proper, compassionate psychological support they need in difficult times.

All of us can be hopeful that the outcry from the grief community around this issue will, like the outcry to de-pathologize homosexuality in the 1970s, result in a de-pathologization of grief. From a practical standpoint, under our current disaster of a health insurance system, we are required to diagnose some kind of “disorder” or there is no insurance coverage for clinical services. In the absence of a complete rethinking of the whole system (oh, for such an outcome!; let’s just hope the misguided politicians won’t succeed in their threat to repeal the so-called “Obamacare” coverage for everyone), we can only hope that whatever happens, good clinicians (and particularly psychiatrists with their ready-meds) recognize that the DSM is at best an imperfect guide, and can tell the difference between grief and either adjustment “disorder,” or major depressive “disorder,” whatever must be recorded as a diagnosis to get coverage.

Dear Fran,
I read your article on how to help the bereaved in Bottomline Secrets email and found it really helpful.

My situation is a little different, but I’m sure someone else has been through it and you may know how to help me.

About 2 1/2 yrs ago I met a wonderful widower. We fell in love and married 11 mos ago. We are both in our 60’s and each have 2 grown children. All the adult children seemed very happy for us except his daughter. She is still very much grieving her mother’s death of nearly 6 yrs ago. She would not come to our home at all. She finally agreed to let her husband bring the kids over a few times last fall. After the wedding last summer she was still pretty “cool” but has gradually “warmed” to me over the winter. What really hurt me was a long letter she wrote to me just before the wedding last summer, where she went on and on about how she felt that I was taking over her mother’s house and taking her father away from her. (We have since sold the house and moved to another state). Anyway, it has gotten a little better over the last 6 mos, but I notice there is still a tension between us. I tried not to take her words and feelings personally, realizing that she is still grieving. Her father felt protective of her (even though she is 36, married and has 6 kids of her own) but I have to tell you it nearly caused me to call off the wedding and definitely took some of the joy from it.

She still visits the gravesite regularly, which seems strange to me as that is not my custom. I have never visited the grave of a relative.

So if you have any advice for the 2nd wife I would love to have it.

Thanks,

“Doris”

* * * * *

BRUISED MUSE replies:

Dear “Doris:”

Thanks so much for writing. I’m very happy you’ve found true love at this point in your life. How wonderful, adorable, stimulating, reassuring, life-affirming, and even (I hope) sensual.

After my mother died, my father, believe it or not, took up with the woman who had been my mother’s hospice nurse. My father was 78, Mary wasn’t even 60. It was a little weird to see my father affectionate with a woman who was not my mother, especially since he’d never been affectionate with my mother, but, well…all I could say was “Good for Dad.” Mary was just a lovely person; she was, after all, a hospice nurse.

It sounds to me as if your new daughter-in-law may be suffering from complicated grief. CG is “an intense and long-lasting form of grief that can take over a person’s life. It’s natural to experience acute grief after someone close dies, but grief usually recedes into the background, and over time, healing diminishes the pain of loss. People suffering complicated grief often say that they feel “stuck.” “Complicated” refers to factors that interfere with the natural healing process, often related to characteristics of the bereaved person, to the nature of the relationship with the deceased person, the circumstances of the death, or to things that occurred after the death.” (I took this definition from www.complicatedgrief.org, the website of Dr. Katherine Shear’s program for CG at Columbia University in New York City.) CG can include intrusive thoughts about death; uncontrollable bouts of sadness, guilt and other negative emotions; and a preoccupation with, or avoidance of, anything associated with the loss. Complicated grief has been linked to higher incidences of drinking, cancer and suicide attempts, and it can be quite distressing not only for those who are experiencing it, but for those who are witness to it. The fact is, complicated grief can destroy two lives at once, and it can get really, really ugly, especially when there’s anger and guilt.

I have the sense you don’t live near New York, where Dr. Shear’s program is located, but if you want to help your daughter-in-law and possibly change the situation, I highly recommend that you take the following two steps:

1) Research psychotherapists, bereavement counselors, thanatologists, psychologists, and/or social workers in her area, and find one who is trained or knowledgeable in the treatment of complicated grief. Many people, sometimes even therapists, are very uncomfortable with grief, and regular talk therapy isn’t always helpful. Research has shown that the most helpful treatment involves, among other things: role playing; narrative therapy; tape recording the bereaved person as she recounts the details of the death and the loss and then replaying it; and journaling.

2) Ask your husband to suggest that she see that therapist. Or perhaps the other sibling, if he or she has been more accepting, could be enlisted in suggesting this.

Beyond taking those two steps, there simply isn’t much you can do, except to understand your husband’s ambivalence, and try to approach your difficult daughter-in-law with as much warmth, empathy, and kindness as you can. I realize that this could be very difficult. Perhaps you could write her a letter, in which you honor her mother and reassure her that you aren’t trying to “take over.”

Your instinct not to take what she says personally is probably right, but at the risk of offending you, I would also ask you to consider your own role here. You may be completely innocent, but here’s Survival Tip #1, from February, 2011. It’s one of my favorite quotes from the brilliant psychiatrist (and novelist) Irvin Yalom, from one of his shorter works, The Gift of Therapy. He says:

“Once an individual recognizes their role in creating their own life predicament, they realize that they, and only they, have the power to change the situation.”

The Bruised Muse has found, in her life and in her psychotherapy office, that life gets a whole lot easier when an individual finally recognizes that she (or he) ONLY has the power to change how she behaves in the world, and how she responds to others’ behavior toward her. She does NOT have the power to change the others’ behavior. And so, with that in mind, I’d suggest you ask yourself seriously if you have offended this woman in some way. (I mean other than by your existence.)

On the other hand, I’d ask: How far does she go in offending you? Does she call you names? Just ignore you? Accuse you of things you haven’t done?

Try to separate what you wish for the relationship with her and her children, from what’s happening, from what’s possible. And do set boundaries. If her behavior is truly abusive–ie, for example, if she calls you names–explain (using “I feel” statements) that this hurts your feelings and you simply won’t tolerate it.

On the other hand, this could have NOTHING WHATSOEVER to do with you. Remember what I said above about the factors related to complicated grief. One factor is the nature of the relationship with the deceased. Was her relationship with her mother particularly difficult, strained, or ambivalent? I certainly don’t suggest you take this up with her, but just knowing the truth of things (the actual truth, not the idealized truth) can help. Knowledge is not only power, it can be comfort too.

As for visiting grave sites, some people find comfort in this. Regular visiting of a mother’s grave after six years MAY be a sign of complicated grief. After 17 years, I’m still OCCASIONALLY drawn to my son’s grave, but I usually stand there for a few minutes, place some small stones on the brass marker, wince at the hollow sound of stone on brass, and leave. I simply do not find my baby there.

Yesterday on NPR, in an interview with Fresh Air’s Terry Gross, Tom Friedman, Pulitzer Prize winning NYTimes columnist, told it like it is on the absolute necessity to go green. Although I definitely disagreed with him on the lead up to the Iraq war (which I always thought not only incredibly stupid but a strategic and moral catastrophe, and he originally supported), Friedman remains among the most brilliant commentators we have in this country. Friedman ought to be required reading (or listening) for every American. Here are a few memorable (approximated) quotes from that interview that drill down (you should pardon the pun) the problem with electing John McCain:

When I heard Rudi Guiliani lead that crowd (at the Repub convention) in chanting “Drill Baby Drill,” I thought, what planet are these people inhabiting? It’s as if on the eve of the advent of computer technology, the Republicans were out there saying “Let’s stick with the IBM Selectric Typewriter.” Type baby type. Type. Type. Type.

If the Petro-dictators–the leaders of the world’s most repressive, anti-modern, anti-woman regimes like Saudi Arabia, which we’re supporting by our addiction to oil, either foreign OR domestic–were up in the bleachers at that convention, they would have been giving each other high fives! They WANT us to remain focused on fossil fuels.

We ought to be promoting fuels from Heaven (wind, solar, etc) rather than fuels from hell (fossil based)

John McCain, whom I used to respect, has been ‘bloody dishonest.’ He’s making people stupid, and it’s frankly disgusting.

John McCain’s support for lifting the federal gas tax for a summer giveaway was absurd and misleading.

We ought to have 100000 innovators working in 100000 garages.

The current tax and production credits for wind and solar energy expire on December 31. A bill to extend them has been brought up in Congress eight times and John McCain didn’t show up to vote eight times. Obama showed up three times and voted to extend. So now, at this crucial time, the solar and wind innovators in this country are at a dead stop, frozen. Nobody is starting new projects. This makes no sense at all.

President Bush claimed we have an addiction to oil, but do you think he invited all these senators, Republican’s and Democrats, to Camp David and said, “Let’s work it out.” Do you think he lifted one little finger, one pinky to help?

When Reagan canceled Carter’s tax credits for wind, Denmark bought the top American wind company and now has the largest wind company in the world.

Now WHICH party and WHICH Candidate are green? George Bush (and John McCain, his twin) don’t want to work it out because the Republican party (of which John McCain is a bonafide member, matter how much they try to distract you with their lipsticked Pitbull and claims of being energy savvy mavericks and change agents), is completely in the pocket of the big oil companies. Make no mistake. The only change they’re going to give you is to move even farther to the right than even George Bush. It’s amazing: Here we have a candidate John McCain who’s made a completely irresponsible pick for Vice President, and in addition has picked just possibly the most anti-green person he could have found. Apparently, in addition to her extremist views on religion, book banning, teaching creationism in school as science, her belief that you can turn gay people straight, and so much else, Sarah Palin also apparently believes global warming isn’t man made. Great. While the rest of the world is moving forward in science and technology and medicine, we’ll be increasing our deficits as Republicans always do; restricting the most promising line of medical research, stem cells; continuing to consume oil at a planet-killing rate; teaching Adam and Eve as science to our young people; arguing over gays; adding to the world’s overpopulation in a resource limited world by pushing abstinence only and restricting access to sex education, birth control and abortion. Now that would be a catastrophe. And the Republicans continue to live in a fantasy world and insist that America is still and always will be the world’s “leader,” and call anyone who would dare speak truth unpatriotic.

Be afraid, people. Be very afraid. Bush calls us the angry left? But I’m not angry, I’m mostly just sad. I grieve for the demise of this country and this planet. But instead of fighting as we go down, some of us will be chanting “Drill Baby Drill.”

If the Bruised Muse hadn’t seen it with her own eyes, she wouldn’t have believed it. Consider for a moment Cindy McCain’s amazing comment about the foreign policy credentials of would-be-VP-in-waiting, Sarah Palin. On Sunday, on ABC’s This Week, beautiful Cindy said:

“You know, the experience that she comes from is, what she has done in government — and remember that Alaska is the closest part of our continent to Russia.”

The Bruised Muse is absolutely certain that this comment couldn’t be an official Repub talking point, but rather is an example of Cindy McCain striking out boldly on her own, having watched Fox News, where commentator Steve Doocy testified to Sarah Palin’s national security experience on Friday by saying that her state, Alaska, was so close to Russia.

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Welcome!

Welcome to my psychotherapy website. I am a licensed clinical social worker with a private practice in Stamford, Connecticut. I also facilitate bereavement groups at the Center for Hope in Darien, Connecticut and in Westchester County, New York. I believe that human beings have an absolute capacity for change, and can also find meaning in even the most profound of losses. When I sit with you, whether in group or with you as an individual, I am present, open, empathetic, non-judgmental, and committed to helping you become all you wish to be, and CAN be. On this blog I post announcements about my psychology related activities, such as bereavement groups, writing for healing groups and speaking gigs. Also, I post interesting psychology-related articles, and articles about grief, written by me or curated from around the web. I have a separate website about my novels, playwriting, and writing projects: www.frandorf.ink. For that, click the link in the tabs above.

Hours & Info

I am available weekdays, some evenings. Call me at 203-536-3531 for a free phone consultation and appointment.

My services

My services are completely confidential. My specialty is bereavement, but I also treat anxiety, depression, relationship issues, self esteem, anger and impulse control, trauma, and much more. I see adults, adolescents, and couples in individual therapy. I also facilitate several bereavement groups, one with parents who've lost children, and another with seniors who've lost their partners. I use an eclectic mix of methods, creative and traditional, to achieve goals we set together, including narrative therapy, cognitive/behavioral therapy, dialectical behavioral therapy, mindfulness, meditation, and expressive arts. As a longtime writer, I have developed the "write to heal" method, and can employ writing as a healing tool with my clients, if they're interested.